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Welcome to the Balanced Bites podcast with Diane Sanfilippo and Liz Wolfe. Diane is a certified nutrition consultant, and the New York Times bestselling author of Practical Paleo, The 21-Day Sugar Detox, and co-author of Mediterranean Paleo Cooking. Liz is a nutritional therapy practitioner, and the best-selling author of Eat the Yolks and The Purely Primal Skincare Guide. Together, Diane and Liz answer your questions, interview leading health and wellness experts, and share their take on modern paleo living with their friendly and balanced approach. Remember our disclaimer: The materials and content within this podcast are intended as general information only, and are not to be considered a substitute for professional medical advice, diagnosis, or treatment.

Diane Sanfilippo: Hey everyone! Welcome to episode 189 of the Balanced Bites podcast. Today I’m talking with an awesome guest, Laura Schoenfeld, who is a Paleo RD, and we’re going to be talking all about overcoming adrenal fatigue. Before I get into our episode, let’s hear a quick word from some of our sponsors.

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1. What’s new for you from Diane [2:07]

Diane Sanfilippo: Alright. So I wanted to give you guys a couple of updates really quickly here. I will be in Roanoke, Virginia on May 16th which is just in a couple of weeks here. I’ll be filming a TV spot on the 17th for a local show, so I think I’m going to try and do an event on the 16th. So stay tuned to the website at BalancedBites.com. Stay tuned to social media and my emailing list. I’ll post the information, how you can RSVP, and find out where we’ll be. It’s either going to be at a Barnes and Noble, or if Barnes and Noble can’t host me for that day because it’s kind of short notice, I’ll probably grab a Crossfit gym and pop in there and be able to say hi to all of you, sign your books and answer questions, and all that good stuff. So stay tuned for that, Saturday May 16th.

Also, let’s see. We’ve got the 21-Day Sugar Detox Coaches Group. If you go over to http://21daysugardetox.com/coaches/, you can click to join that group if you’re interested in becoming a coach when the program enrollment opens up. It will be only open for enrollment to a very limited number of people. That’s in order to keep my staff from going crazy and being able to support everybody to the fullest, we can’t have an unlimited number of enrollment, so it will be limited just for a short period of time. But if you’re curious about that, just join the Facebook group, it’s kind of an interest group where I’m sharing all of the information, and that’s where I will let people know first when enrollment is open. So if you’re in that group and you’re curious about it, that’s kind of the place to be.

I think that’s it for this week on updates. Just make sure you’re following on Instagram and the emailing list to stay tuned for what else is new.

2. This week in the Paleosphere: Diane’s PaleoFx takeaway [3:47]

This week in the Paleosphere, I just wanted to touch on a couple of really quick things from PaleoFx. I just came back from Austin; I think my voice is a little bit strained; I was talking for probably 3 days straight. I wanted to just touch on a couple of quick takeaways that I got from this years’ event. And if any of you have been hearing about PaleoFx, it takes place in Austin every year, usually spring/early summertime. It’s a great event, it’s a really fun time to come just meet up with other paleo like-minded folks, meet your favorite bloggers and authors and learn a whole bunch as well as eat your way around the expo floor. It’s not like most health or fitness expos where the food or snacks are just supplements and weird drinks; it’s all really awesome stuff. So definitely check it out in the coming years.

A couple of the big takeaways that I had which I thought were really fun and interesting; 1) the talk about sustainability. Diana Rodgers, her new book, The Homegrown Paleo Cookbook, is one that’s kind of at the forefront of getting this whole sustainability thing on everyone’s minds, whether it’s backyard chickens and having a little garden or farm of your own, or just supporting local farmers and folks who are doing it right, which we talk about all the time here on the show.

That’s definitely a big topic that’s kind of coming up. I know Diana was selling a T-shirt that says Paleo 2.0 sustainability > abs, and she and Robb Wolf are definitely leading the charge on that stuff. I know Robb has been talking about that for years, and Diana runs a farm up in Carlisle, Massachusetts with her husband. I think it’s just a great topic, and we all need to tune into that a little bit more. You guys know that Liz is kind of running a little farmstead/homestead over in the middle of the country there, so she’s kind of really tuned into that. They have a podcast called Modern Farm Girls, I believe. So if you guys are interested in learning more about that stuff, check it out. Definitely check out the Homegrown Paleo Cookbook.

I would say stay tuned for more information on the whole sustainability topic, because I think, as we move forward, as this community grows of course we want to be welcoming and embracing of the folks who are newer and we’re teaching about what are the basic food choices to make. But from there, the focus this year was a little bit less on all the nuances of, how many carbs do I eat and all of that, and more towards how can this affect the greater good, and I thought that was really fantastic.

Now the other side of that for the personal approach of, what should I eat, how do I tweak things. My favorite talk was from Mark Sisson, where he was really just diving into how do you tailor things for yourself. And his little acronym cracked me up; it was WCIGAW, and it stood for, What can I get away with? And I absolutely love that, because I often post pictures of myself and my fiancé, Scott, eating something like tacos in organic corn tortillas. For us, we do fine with that now and then, and I like to post pictures like that on Instagram or wherever, because paleo is how we consider ourselves to be eating most of the time. It’s not a religion, we’re not dogmatic about it, but for us it is also that, what can I get away with? What can I eat now and then that doesn’t make me feel junkie, it doesn’t take me out for multiple days or a week, and also that I really enjoy. That’s a big think Mark talked about; you have to enjoy what you're eating.

We talk about sardines, and liver, and all this stuff that we know you guys are making crazy faces at. We don’t want you to eat it if you absolutely hate it, but we also do want to challenge you to find ways to enjoy it, and then from there move on to, I think Vital Proteins is a brand that’s actually making a beef liver capsule now. I think as adults we need to try these things 17 times in 17 different ways to see if we can find a way to like it, whether that’s putting a little bit of ground liver into your meatballs, for example, not just eating a slab of liver and onions, or putting sardines into a sardine salad mixed with some healthy mayonnaise, something like that, not just eating them straight out of the can if that’s not for you.

I definitely want to challenge people to find ways to enjoy or at least not detest this challenging food. That being said, you should enjoy the food that you’re eating. So I’m kind of right with him on that. The one other thing that Mark touched on, which I loved because, you know, I think everyone gets spun out about their little hang-ups that they really don’t want to give up, whether it’s coffee or alcohol. But Mark was talking about how every night around 3 a.m., he was waking up, just mind racing. He thought it was typical entrepreneur, running a big company, lots of stuff on your mind, and he would just kind of wake up.

So he decided to look into some traditional Chinese medicine charts that talk about how the liver is really active at that time, and it could be a sign that there’s something else going on. He talked about how each night he generally would be drinking about 2 glasses of red wine, which can be healthy for some people but he’s read recent studies about how that may or may not be the best approach for everyone, and he stopped drinking 2 glasses of red wine, and found that he was able to sleep through the night.

I think it’s just another really good example of seeing what works for you, but also questioning if it is really working for you, and continually testing things. I know lots of folks who are leading the paleo movement are really big into a little bit of alcohol here and there, or even larger amounts. I’m not a big drinker, I just don’t care for it. I don’t think I’m missing out on anything by not drinking regularly. I think everyone has to make that decision for themselves, but it was just a really refreshing take that Mark shared that and said, hey you know I switched to this, I think he’s doing a gluten free non alcoholic beer or something, just to get the ritual there after dinner, something to kind of sit back and enjoy but without the alcohol that was disrupting his sleep, because we do know how important sleep is. I thought that was really great.

The very last thing I want to say about PaleoFx is that I was blown away by the reception to, not only my individual talk, which was I think there were over 200 people crammed into the room, sweating our butts off. Or, sweating our elbow pits off, as I was saying. I was holding the microphone and the inside of my elbow was dripping sweat. {laughs} Just was able to talk about stuff I’m really passionate about outside of the nutrition world and obviously to a group of folks who are into health and fitness and nutrition. I think there were tons of coaches and nutritionists and gym owners and all of that in the room.

We just had a really great discussion; I probably spoke for half the time and took questions for about half the time, which is always my favorite thing to do. But then I was able to kind of take it further in a couple of workshops that we did, myself and Naomi Seifter, I always forget how to pronounce her last name, and then Taylor from Epic bar was with us for one of those. We just had a great time talking to all of you guys about business, and steps that we take and experiences that we’ve had, ups and downs, and I was able to introduce kind of the process that I take with everything in my business, whether a tiny project or a big project, something as small as a social media post, to something as large as even to get up to speak in front of the group.

Which I am not a huge planner, scripter, rehearser. I have my ideas outlined and just kind of speak from my gut. I do that now, I don’t have a script that I’m going through now, as you guys can probably tell, but I don’t script what I do. I take very careful consideration to only speak about things I feel educated and experienced on. So introduced my sort of business cycle that I wanted to explain to people, and I will find a way to get that on the website soon, so stay tuned for that if you’re curious.

3. Shout Out: Squirrel & the Bee [11:46]

Diane Sanfilippo: Alright, really quickly my last little shout out here that I want to give is to Squirrel & the Bee. It’s a grainless bake shop in Milburn, New Jersey. I believe they also have some items you can order online at http://www.squirrelandthebee.com/. Really fantastic little café. Their coffee is amazing, their decaf is amazing. They make their almond milk from scratch, they make their coconut milk from scratch. I absolutely love being able to sit there, do a little bit of work, have my coconut milk decaf latte with just fresh, delicious coconut milk, and I just wanted to give them a shout out because I love what they’re doing.

They’re named Squirrel & the Bee because they use primarily almond flour and honey, and they’re locally sourced. I just thought that was really fantastic; at least the honey is locally sourced. I’m not positive about the almonds. But they also do some coconut flour based stuff now and then. And if I asked them ahead of time, they’ll make it, because she knows I can’t eat almonds. But it’s a fantastic shop, so definitely check it out if you’re anywhere in the area, and check out their website to see if there’s anything you want to order from http://www.squirrelandthebee.com/.

4. Introducing our guest, Laura Schoenfeld, Paleo RD [12:53]

Diane Sanfilippo: Alright, so I’ve been yapping it up long enough. I want to introduce my guest today, my friend and amazing paleo RD, Laura Schoenfeld. Laura Schoenfeld is a registered dietician who is passionate about making traditional diets healthful and accessible for all of her clients. She runs a private online nutrition practice, and is a staff nutritionist and program consultant for both Chris Kresser and Paul Jaminet. She has co-created a new online program, Paleo Rehab, and is the co-host of the Ancestral RDs podcast. She loves helping her clients discover their ideal diet using science-based, personalized recommendations. Hey Laura!

Laura Schoenfeld: Hello Diane! I’m so excited to be here finally.

Diane Sanfilippo: {laughs} We’re, uh, we haven’t seen each other in quite a while! I was so bummed to not get to see you this time in Austin, but it’s great to get to chat with you this week.

Laura Schoenfeld: Yeah, well the first year of business is not a joke.

Diane Sanfilippo: {laughs}

Laura Schoenfeld: So I’ve been saving all my money for making sure the business is going well. I’m hoping in the next year or so I’ll be able to start doing the conference circuit once again.

Diane Sanfilippo: Yeah, for sure. It’s a fun time. It’s definitely a lot of money in terms of travel and all that stuff. So we will probably have to talk on the Build a Badass Business podcast about your business and how you’re getting things started and all that, because I’m sure lots of other nutritionists, RDs, etc. would love to hear your story, so we’ll do that over there one day.

Laura Schoenfeld: Sure. Well you're my business guru.

Diane Sanfilippo: {laughs}

Laura Schoenfeld: And I always love how you give me little tidbits about things I should do if you see me doing something really dumb, which is pretty often. I’m not the most business savvy person. I’ve spent most of my time learning how to help people with nutrition, so the business side of things is very new to me, but I’ve learned a lot in the last year.

Diane Sanfilippo: Well I’m happy to help. {laughs} You’re good at taking constructive feedback. I try and tread pretty lightly, but when I’m good friends with somebody and I feel like I want to help them out, I just usually kind of blurt out whatever I see going on.

Laura Schoenfeld: Probably mine, but that’s not because I work at it, that’s all genetics.

Diane Sanfilippo: {laughs} My hair is very small, genetically. Anyway, today we’re not going to be talking about our hair. We’re here to talk about your new program, which I’m really excited about. Liz and I have done, I think at least 3 episodes dedicated to the topic of adrenal fatigue, and have had other experts on talking about it, and I’m excited because this is the first time we’ve seen kind of a step by step program created that folks can access without necessarily having to invest thousands of dollars to go to a practitioner. Your new program is called Overcoming Adrenal Fatigue, and it’s within this Paleo rehab umbrella, correct?

Laura Schoenfeld: Yeah. So my business partner, Kelsey Marksteiner and I, who is another staff dietician at Chris Kresser’s company, I guess we call it now. {laughs} She and I, back in, I think it was back in October when we started playing around with ideas on what kind of program we wanted to put together. We knew we wanted to do an overarching company called Paleo Rehab where, it’s kind of a double entendre with that business name. Part of it is using a paleo diet to rehab people’s health; and then the other side of things is helping people who have gotten too deep into the paleo dogma.

Diane Sanfilippo: Mm-hmm.

Laura Schoenfeld: To rehab out of that kind of mindset to make sure that they’re not just following recommendations blindly that don’t make any sense for their health needs. So we had a couple of ideas about different conditions that we thought we were seeing a lot of clients having these issues, we were noticing that a lot of them were getting better from pretty similar recommendations of changes to make, so we were like, why don’t we make this an online program?

And the reason we picked adrenal fatigue is actually, not only because both Kelsey and I have struggled with, I mean she had stage 2 adrenal fatigue. I have had anxiety issues for pretty much most of my life. I have a couple of hormonal imbalances from stress, especially after this first year of business, it’s almost impossible to avoid. But we both felt personally passionate about adrenal fatigue issues because of our health experiences.

And then we also realized; I mean, part of running a business is finding a hole in the market where there is nothing that is being provided, and we realized that there really are no online programs for adrenal fatigue specifically. Obviously, especially not in the paleo community. So combining our passion for it, and then also realizing there was such a huge need for it was kind of our impetus for creating the program. Like I said, we started back in October getting all the stuff, putting pen to paper, writing all the modules, that kind of thing. The last couple of months have been just figuring out how to get it out there into the world and make sure people know about it. Because, {laughs} as I’m sure you're aware, it’s not just enough to make the information, you’ve got to make sure people learn about it.

Diane Sanfilippo: {laughs} Yeah. I actually, I love the idea of an online program because we get so many questions and people are like, where do I find a practitioner. We’re going to talk a little bit about that, and I have a huge list of questions for you from our listeners and followers. But it’s hard to find a practitioner, and it’s even harder if people are not in a major metropolitan area where these topics are kind of more at the forefront. There are naturopaths and all that kind of group of resources for people. I do think a huge percentage of the work is completely independent of a practitioner.

Laura Schoenfeld: Mm-hmm.

Diane Sanfilippo: It’s really about, I’m sure what you cover in the program, diet, lifestyle, mindset, all of those factors that we have so much power and control over that stuff, so I think it’s great that people can get this kind of step by step and learn a whole bunch about it, and then get the action plan, too.

5. What exactly is adrenal fatigue [18:48]

So why don’t you talk a little bit about just the basics. What is adrenal fatigue? I think one of the biggest questions that people have is, what’s the difference between your typical, “I’m tired today,” or this week, or this month even, life stress etc., what’s the difference between that and what we’re really talking about with adrenal fatigue where it’s this diagnosed, dig your way out of it issue.

Laura Schoenfeld: Yeah, well before we talk about what adrenal fatigue is, I need to clear up some confusion about the term itself. I’m sure a lot of people have seen those articles online saying, adrenal fatigue is not real, it’s a made up condition, it’s not a diagnosis. Which actually, that’s true. It’s not a diagnosis in conventional medical terms. Adrenal fatigue, as we call it, is not actually a medically recognized health issue. But, HPA axis dysregulation is, and that’s even in conventional medicine. That’s not one of those woo-woo alternative health issues, it actually is something that medical professionals, at least the ones that are keeping up with research know about. There are studies that are run on this, this is something that’s very prevalent in the literature.

So I want everyone to understand that they’re essentially the same thing, when we talk about adrenal fatigue, we’re talking about HPA axis dysregulation. It’s just important to understand what HPA axis dysregulation is, because if you go to your doctor and say, I think I have adrenal fatigue, they’re potentially going to not know what you’re talking about, or they’re going to think that you’ve been Googling too much.

Diane Sanfilippo: {laughs}

Laura Schoenfeld: And you know, I don’t want people to be using a term that’s actually not really even accurate to the condition itself. Just as a brief overview, and I know that you guys have talked about this before, so please stop me if I’m repeating.

Diane Sanfilippo: No, it’ll be great. We’ll link to the episodes where we talked about this too, because I did get into some of this, but it was probably almost 3 years ago now.

Laura Schoenfeld: Yeah.

Diane Sanfilippo: So we’ll dig some of those up for people to hear again, but absolutely, go ahead and explain it, because I think that’s critical.

Laura Schoenfeld: Sure. Well, the HPA axis stands for the hypothalamic pituitary adrenal axis. And that is the control center for your body’s stress response. So when you get stressed, your hypothalamus, which is a part of your brain, releases something called corticotropin releasing hormone. And that’s the first of a cascade of a variety of hormone changes that eventually, once it goes through the pituitary gland to the adrenal gland, results in the production of cortisol, which we all know is the major stress hormone. And that’s something that’s very normal. It’s completely biologically appropriate, it something your body was designed to do, so producing cortisol is not a problem.

The problem is, in the modern world our HPA axis is constantly being activated. Instead of being activated here and there based on stressful events; they always use that chased by a saber tooth tiger example. That’s the fight or flight response that is normal in hunter-gatherer societies, our ancestral heritage. But in the modern world, we’re being exposed to stressors all the time. So things like money problems, or traffic, or waking up to an alarm clock, even. Those are things that can stress your body out, and it’s something that happens all day, every day for a lot of us. Especially us entrepreneurs.

It’s funny, because when we were doing the research for this program, we found out that you would think that the high stress, super traumatic events like a death in the family, or divorce, or any of those major, major events would be a bigger impact on your HPA axis, but actually what the research says is those chronic daily minor stressors that are always there that aren’t being dealt with that are constantly activating the HPA axis are actually more harmful. I thought that was really interesting, because we think, oh well I’m not that stressed out. I have a normal stressful life, my job kind of is stressful, but I’m happy with my significant other, or my family life is pretty good, I shouldn’t have adrenal fatigue. But that’s not really the case, and it’s actually those chronic daily stressors that are a bigger problem.

Our stress levels now, I think even in the last couple of decades let alone the last thousand, 10,000, however many thousand years you want to go back, our stressors are a lot higher than what they used to be. So we have emotional stressors, financial issues, work struggles, and then chronic health conditions. I’m sure a lot of your listeners have things like autoimmune disease, or gut dysbiosis, that kind of stuff, which those chronic health conditions can also activate the HPA axis.

So when you combine all these different things, like not sleeping well and exercising the wrong way and under eating and having a job that’s stressful. As those things start to build up, your HPA axis gets more and more activated, and eventually it starts to stop responding to the activation signal. So you start off with some very high cortisol levels when you're under this chronic stress, and then over time, as a survival mechanism, your hypothalamic pituitary axis starts to down regulate. So your adrenals stop pumping out cortisol, you become less and less sensitive to the effects of cortisol, you become cortisol resistant. And this ends up becoming what’s called HPA axis dysfunction.

So hopefully that kind of gives people a good understanding of what adrenal fatigue is. The main patterns are either high cortisol, which is what we call stage 1, and then over time your cortisol starts to drop, and stage 2 and stage 3 is where it’s either very low or essentially flat lined, so you’re not producing almost any cortisol in response to the stress that your under. That is the very basic overview of what adrenal fatigue is. Of course, we cover more of this in our program, but hopefully that gives people a really good understanding of what adrenal fatigue is. It’s not just being tired.

Diane Sanfilippo: Mm-hmm.

Laura Schoenfeld: It’s not just being stressed. Certainly, if you're constantly stressed, it can lead to adrenal fatigue. But not everyone will respond to stressors in the same way. Certain people just don’t handle stressors the same way. It also depends on what kind of lifestyle you're living. We talk about, in our program, how overtraining can lead to HPA axis dysregulation, and overtraining is one of those things that’s completely dependent on the individual, not only their genetics and their tolerance of exercise from a genetic stand point, but also their lifestyle.

Professional athletes are getting the sleep that they need, they’re getting all the food that they need to eat. They have a massage therapist and personal trainers and that kind of stuff to keep their body functioning at a high level and keeping their stress low. And then you have those weekend warrior type athletes where they have a 9-5 job, or maybe they’re working 9-7 and they’re going to Crossfit after work, and they’re not sleeping well, and they’re under eating because they’re trying to lose weight. All of those things add up to eventually that HPA axis dysfunction.

From a symptom perspective, if you’re looking to determine the difference between normal daily tiredness from, maybe you just didn’t get a good night’s sleep before, sometimes it can be hard to tease out. Testing can be really helpful in that situation because you can actually see what your cortisol levels are doing. But generally I would say, if you get a good night’s sleep, and you wake up and you’re still exhausted, then that could be a good sign. If you’re getting sick more often. Maybe you're the kind of person that doesn’t really get sick very much, but then all of a sudden you start getting colds or viruses, that kind of stuff, that could be a sign. If you’re an athlete and you're getting injured a lot; getting tendons or ligament injuries, joint injuries, that kind of thing, that can also be a sign, as well.

There’s lots of actual symptoms of adrenal fatigue, it’s not just tiredness. But tiredness is one of those things that just never seems to go away when you have adrenal fatigue.

Diane Sanfilippo: That’s a really, really good overview. I think it almost, as with other hormones and chemical messengers in our body; you know a lot of times we talk about insulin resistance, and type 2 diabetes being, it’s not just high insulin levels, it’s high and then your body ignoring the signs because it becomes resistant to that message.

Laura Schoenfeld: Mm-hmm.

Diane Sanfilippo: It’s just too much all the time, and it’s a protective mechanism that our body has to shut down certain functions, because it’s like, ok too much, we need to self regulate. The body is always looking for homeostasis for better balance. So when your body kind of goes into this state of the HPA axis dysregulation, it’s your body’s physical way of telling you, no more. You know?

Laura Schoenfeld: Yeah.

Diane Sanfilippo: No more of this stress. Now I’m going to make you tired because I don’t want you to keep doing whatever that is.

Laura Schoenfeld: Mm-hmm.

Diane Sanfilippo: The physical down regulation of your energy is a sign that you should not continue to try to put out that much energy, whatever that is. Whether it’s emotional, physical, etc. I think that’s a really good thing for people to think about. When I was talking about this in the workshops for example, I talk about our stress levels as multiple sizes of beakers, where everybody’s beaker is kind of a different size, and it starts out with our physical constitution at a young age, which is not certain things we can all control.

We’ve all got different sized beakers, I’m picturing the chemistry lab, and different stressors just start to fill it up. And sometimes you hit the point where one extra drop of stress that goes in, the point where a beaker overflows, it’s only just 1 drop of something at that point. A lot of times I think people have the mindset that, well I always did this. I was always a marathon runner, or I was always a crossfitter, or I always ate this way, or whatever the case may be, so it’s like, why now. And it’s like, well your body has had enough! {laughs}

Laura Schoenfeld: Right.

Diane Sanfilippo: And it’s telling you it was actually never ok, but your body was handling it differently for a period of time. I just think that’s something that consistently happens, where people just have that feeling of, but I always did this. You know? This was never a problem before. It’s like, well maybe it was but your body was able to handle it until you just overflowed on that stress level.

6. How do we know when it’s really adrenal fatigue? [29:23]

Diane Sanfilippo: So, how do people know if it’s adrenal fatigue and not something else? I guess that’s kind of a tricky question, but I think the real question here is also, what if it’s a physical, like an infection or something else, that maybe the person is like, I don’t have financial or emotional stress. I’m really not overtraining. How do I know if this thing is actually affecting my HPA axis and causing this adrenal fatigue, or if it’s some stressor that way. How do we know what it is?

Laura Schoenfeld: Yeah, that’s a great question, and something that Chris Kresser always says that I love is test, don’t guess. So obviously functional medicine testing, there’s a lot of different options that exist out there. With adrenal testing, it’s pretty simple. It’s a salivary test, so you basically get this little kit that they send to you, and you take 4 saliva samples over the course of a day and then send it back in, and they’ll give you your functional cortisol results. Which I think for most people, that’s a pretty easy test to do. A lot of people can order it themselves. There are a few state that you can’t order tests yourself, unfortunately. I know New York is a really bad one for that kind of stuff. But you can certainly go find a functional doctor that can order those tests for you.

I really think that people, if they are really feeling that they have adrenal fatigue, that they do need to get tested. And I’ll use myself as an example here, actually. I got a cortisol panel done, I think it was back in December, which I’m sure at this point it’s even worse after this program launch, and I was actually in a car accident in January, so there’s been a couple of big things in my life the last couple of months that probably affected that.

But I got my, it’s called a diurnal cortisol rhythms, you get 4 tests done. I got my DHEA tested, which DHEA is a precursor to cortisol, and sometimes that can be low if you have high levels of cortisol, and then I also got my sex hormones tested. So they did 3 different types of estrogen, progesterone, testosterone, and I think that might have been it. Because I had been feeling adrenal fatigue symptoms, my work this year has been kind of stressful, and I just wanted to see what was going on to see if I should do anything from a supplement perspective to help with that.

And it turned out that my cortisol was completely normal, and my naturopath said, this is actually a perfect cortisol level, which was great. But then the problem was that my progesterone was essentially in the toilet. Which, I can’t go into a lot of detail on that, but essentially progesterone and cortisol share the same precursor hormone, so the general picture that I got from that testing was that, yeah my cortisol is ok, but I’m using all of my precursor hormones to make cortisol instead of progesterone. So that was really helpful for me, because I could actually use that information to make the changes that were going to be the most helpful. Not that I recommend hormone replacement therapy; I certainly don’t work with hormone replacement therapy, because that’s outside of my scope, but I am doing a little bit of progesterone replacement through my naturopath, and I can’t even tell you the difference it’s made in a lot of the symptoms I was having.

So that’s just kind of an anecdotal story on my part to show people that getting the testing can be really helpful, because you don’t want to be doing something that isn’t actually helping your problem. And the with the cortisol testing, you want to make sure that you’re taking the right supplements for your cortisol patterns. If you have very high cortisol, you don’t want to be taking an adrenal supplement that’s actually is meant to raise cortisol, which is something I see all the time. People taking the wrong supplements for their particular stage of adrenal fatigue.

If you have low cortisol, again you don’t want to be taking ones that are lowering the cortisol. So knowing whether or not you have high or low cortisol can really change the way you deal with your symptoms. And then if you find out that you don’t have any cortisol issues, you can go get tested for other things like hormone imbalances, maybe you have a thyroid issue, maybe you have a gut issue, autoimmunity, that kind of thing.

I wish there was an easier way that I could just give people a check list and say, oh, you have adrenal fatigue.

Diane Sanfilippo: Yeah.

Laura Schoenfeld: But it’s just not possible. And even though that would be cheaper and easier, it’s just not going to get people the results that they’re looking for. Ultimately, I’d rather somebody spend the money and get the testing done and get the actual help that they need as opposed to just saying, well, I feel tired so I’m going to take this adrenal booster supplement.

Diane Sanfilippo: {laughs} Right.

Laura Schoenfeld: And have no idea if this is even helping me.

Diane Sanfilippo: And I think, too, people need to potentially get to the root cause of it. Because, for people who are, for example, entrepreneurs, for me when I’ve gone through this on my own, a long time ago I was working with a practitioner on it, and then I would be in these stages of just depletion after working on a book, for example. I knew that the cause of it was emotional physical stress from that, it wasn’t that there was an underlying infection. I could very quickly pinpoint the source of my stress. {laughs}

Laura Schoenfeld: Yeah, it’s pretty obvious.

Diane Sanfilippo: Yeah, which isn’t always the same for people. I think sometimes people can’t pinpoint it, but I think, one of the questions that people have, people have a lot of questions about supplements, and I’ll get to a couple of those quickly. But one of them is, how do I know if what I’m doing is right, and obviously we would agree that testing is the right way to go. I know that there are some practitioners that say, ok, if we test and we put you on certain supplements and then we retest and nothing changes, then that wasn’t the right protocol for you. Most of the supplements aren’t going to be so severely detrimental to anybody. They’re usually not to crazy. Obviously, some of the hormone replacement or even the cortisol precursor, any of that stuff, DHEA replacement will be a little bit more severe. But I think it’s really important that people get tested.

7. Under eating and its consequences [35:25]

Diane Sanfilippo: I know that you talk a lot about nutritional changes, and I think of the quickest bullet or shotgun approach to figuring out, are you just driving your body into this adrenal fatigue, HPA axis dysregulation, from your food choices, what is kind of the number one thing that you would say, look if you think that you’re just under eating or not eating correctly, that people can do to try and get that moving in the right direction, and give it a month or so and say, ok, if you’re feeling a ton better from these changes, then it was probably just something simple for you, for those people who feel like they don’t have a lot of life stressors or whatever the case may be, they’re just eating paleo. Which I know is kind of the Paleo Rehab concept there.

Laura Schoenfeld: The cool thing about our program is even though our ideal situation is that people get tested, and they take certain supplements to deal with the specific cortisol patterning that they’re experiencing, that’s just the optimal situation. That’s certainly not 100% required. We always repeat in the program that the supplements are totally option; if you don’t want to take supplements, you don’t have to. The great thing about the other parts of the program, like the diet, the lifestyle, the mindset stuff is, I honestly feel like, even if you don’t have adrenal fatigue, the recommendations we make are actually pretty good for, I’d say 95-100% of people.

So, if you only want to make the diet and lifestyle changes to see if you can deal with some of those stressors that you’re considering are possibly an issue, that is potentially enough to get you where you need to be, and we’ve had clients that, that’s all they did was change their diet to actually match what their nutrient needs were, and they started to feel better pretty immediately.

The most common issue that I see in my adrenal fatigue clients’ diets, and this is people who are doing paleo. I tend to specialize in people who are already on paleo. They’re either eating too low in calories in general, so they’re just not eating enough for the amount of exercise they’re doing, or even just for their basal metabolic needs, or it’s too low in one or more macronutrients. So in paleo, the most common macronutrient that tends to be deficient is carbohydrates, and then the interesting thing is, I’d say it’s more of a problem with women, but a lot of people are actually not getting the amount of protein they should be getting at the right intervals during the day.

What I would say for anyone who’s wanting to start addressing a diet issue and seeing if the diet is actually a problem, there’s lots of online calorie calculators that you can use to estimate your daily needs. We actually have a free eBook on our website that you can download, and we give you an exact one. We link to it, so you can actually go to that link.

Diane Sanfilippo: We’ll link to it from the show notes, too.

Laura Schoenfeld: Yeah, sure. I’ll send you that. So you can put your height, your weight, your gender, your activity level, stages of life, that kind of thing. For example, if you’re a woman who’s breastfeeding, you’re going to need 3-500 more calories per day than a woman who is not, so the calculation is going to be a starting point. But depending on the person, you may need even more calories than the calculator is able to estimate.

Basically what you do is you put all the information in, and it will spit out a general calorie recommendation. Now of course, there’s so many people online that say, well it’s overestimating or underestimating. I’m not a calorie calculator, so I don’t really care if it’s high or low by 1 or 200 calories per day. I want people to use that number, and then track their intake for a few days, and determine if they’re actually anywhere near that number. You can use online programs like My Fitness Pal or Chronometer to track your intake, and compare that to what that calorie estimator puts out to you. I’d say 9 times out of 10, my clients are under eating by at least 500 calories per day or more, which is a really major stress on your body, and it’s really terrible for adrenal health.

So, this is a huge problem for women, especially women trying to lose weight. They’ll not necessarily go on a crazy low calorie diet, but maybe they’re eating 1500 calories per day, and then they do this calorie calculator based on the amount of exercise they do, and the calculator says, you need 2400 calories in a day to maintain your weight. And it’s just this 900 calorie per day difference that everyone is like, well it’s supposed to help me lose weight faster, and it’s funny because our clients in that situation are mostly the ones that aren’t losing weight at all on this low calorie, high exercise plan.

But I would say that’s the easiest way to ballpark if you’re getting anywhere near the amount of calories that you should be on a daily basis. And then if you're not, you may notice, ok I’m eating 40 grams of carbs during the day, maybe I can jump that up to 80 or 100 just to start eating a little bit more. Or maybe I need to throw in a snack in there, have a post workout snack to make sure I’m getting that extra 500 calories. You’re just going to have to see what you’re currently doing and compare that to what the calculator says.

Again, of course, the calculator is just an estimate, and you can use that information to go up or down, depending on if you start to feel really energetic, eating 1800 calories a day but the calculator said 2000, then maybe you don’t quite need 2000. Or maybe you bump it up to 2200, and you're still feeling really tired, and maybe you need more like 2500, because you're burning more calories than you think you are. So it’s just a starting point, but I would say that’s the simplest way for people to assess whether or not they’re simply under eating and over exercising and causing their fatigue symptoms.

Diane Sanfilippo: I think that’s a huge thing with when people go paleo. I see it when people do the 21-Day Sugar Detox too where they’re just like, I’m really tired, or hungry. {laughs}

Laura Schoenfeld: {laughs} I’m hungry, what do I do?

Diane Sanfilippo: I know, and that’s kind of why, whether it’s just a general paleo approach, or it something like the Sugar Detox, planning and preparing and having food ready is so critical. Because as soon as you start limiting your food choices to choices that you weren’t used to making; for example, you were at your office and people used to go out for sandwiches, or pizza, or whatever the case may be, and now you don’t have that choice anymore. If you don’t bring something with you, or you’re not prepared for what choices you’ll make, a lot of times people will either just totally go off the rails, or if you really are kind of the type A where you’re sticking to the rules, people just skip a meal because they don’t know what to eat or they don’t have something to eat.

It does end up backfiring; either it backfires because you end up eating all kinds of stuff you didn’t want to eat, or you’re just not fueling your body. I think the thing to remember when it comes to fat loss in general and feeling good is that we want to remove as many stressors as possible. And under eating is a stressor.

Laura Schoenfeld: Right.

Diane Sanfilippo: Not having enough nutrition for your body to just have your body operate on a daily basis. And it is kind of this weird, delicate balance where over nutrition can be a stressor; eating too much can be a stressor. But also under eating. I just think people don’t want to own that in terms of the calories in, calories out thing.

One thing actually that I think Mark Sisson said in his talk again; I love Mark Sisson. How could you not.

Laura Schoenfeld: Me too.

Diane Sanfilippo: He is just so real about things. But his approach on the whole calories in, calories out is, yeah there is this thermodynamic thing going on; however, determining whether or not our body has the capacity to burn those calories is very complex. So it’s not even just about our basal metabolic rate and our exercise, it’s also about this internal stress, right? Because that internal stress going on, if your body has been very stressed, if I’ve been very stressed working on something, I’m burning more calories by being emotionally and physically stressed. It’s actually burning more calories.

Laura Schoenfeld: Yeah.

Diane Sanfilippo: You know, people think, ok eat less, exercise more, or whatever the case may be. But if your body needs more calories for some reason, and you’re not giving it to your body, then it’s causing a stress, then it’s not going to let go of weight. So it’s actually {laughs} it’s kind of a sick problem, where your body is either going to hold on to weight because you're taking in too much, and it doesn’t need it, or if you’re not taking in enough and it’s not ready to let go of it for some reason. It’s just too stressed.

Laura Schoenfeld: Yeah, I don’t know if I’ve ever had a patient where they were just eating too much, and they weren’t losing weight. I’m trying to think if I’ve ever had somebody in that situation. And it may just be because I attract the kind of clients that are “following the rules”.

Diane Sanfilippo: Mm-hmm.

Laura Schoenfeld: But I think it’s important to remember that we like to think that we can control our body’s inputs and outputs.

Diane Sanfilippo: {laughs}

Laura Schoenfeld: {laughs} But it’s really not the case. Your body knows more about what it needs than we do. We try to logic our way into things, and our body is going to do what it needs to do to keep us safe and healthy, like you said, in homeostasis as well as possible. And if you're under eating and over exercising; or just under eating. If you’re not somebody that’s super active, but you're under eating for your daily needs, your body is going to say, ok I don’t know if I’m going to be getting enough food in the next couple of weeks, so let’s store this as body fat just in case we start going into a famine, or something like that.

Diane Sanfilippo: Mm-hmm.

Laura Schoenfeld: And then even if you start eating more for a couple of days to try to undo the damage, the body is saying, ok well maybe this is a short period that I’ll have that food, and I’m going to store this.

Diane Sanfilippo: Right.

Laura Schoenfeld: So usually when I’m working with people who are in that downward spiral of cutting calories, adding more exercise. Ironically, I just spoke to a woman this morning about this. Her trainer told her; she’s gaining weight, she has Hashimoto’s, and she’s eating like 1200 calories a day, and her trainer told her to add on more cardio. And I just wanted to…

Diane Sanfilippo: Scream?

Laura Schoenfeld: Punch my computer. {laughs} Yeah. And I felt so bad for her, because it’s like, she has this autoimmune disease, which I would not be surprised if either was caused or exacerbated by her diet and exercise pattern, and her coach is telling her to do more of that same thing that’s causing that problem.

Diane Sanfilippo: Right.

Laura Schoenfeld: It’s something I see all the time. Especially with women, I was saying you get this women’s health perspective where, oh I need to eat 1500 calories a day to lose weight. And it’s not.

Diane Sanfilippo: Right.

Laura Schoenfeld: I mean, you might lose weight in the short term, but really.

Diane Sanfilippo: That is kind of the sexy part of cutting calories, is that sometimes it works at first, because of course you’re putting less nutrition into the body and until your body catches up and realizes that you’re not giving it enough, it’s kind of a seasonal thing. It can actually, you certainly can lose weight by under eating for a period of time.

Laura Schoenfeld: Yeah.

Diane Sanfilippo: And I think a lot of people listening are like, yeah that worked for me for a little while. And then at some point, it doesn’t work because your body is trying to achieve that balance. So this is kind of the same thing, even with nutrient deficiencies, right? We don’t experience the impact of nutrient deficiencies for a long time, because the body is sourcing, pulling it from stores to try and balance things out, and then eventually it becomes a problem and it’s hard to dig out of it. It’s kind of the same thing.

8. Quick overview of supplements [47:09]

Diane Sanfilippo: So we have a couple of other types of questions here. I know you touched really briefly on supplements, and I’m sure because it is so specific to what the issue is, we can’t talk about over arching, ok here’s how everyone should supplement. But people are just kind of curious about it in general. What are the kinds of things that they will probably be learning about in terms of supplements. Just really high level brief information, because I don’t want people to take this podcast and just run and go take everything they hear about.

Laura Schoenfeld: Go run to Whole Foods.

Diane Sanfilippo: Yeah.

Laura Schoenfeld: Yeah, I mean, we always give the disclaimer that the supplements are the general recommendations. We always remind everyone that any supplement changes should be made under the care and guidance of your personal health care provider. You know, that’s something that’s not just to cover ourselves from a liability perspective; we actually really do want you to talk to your personal health care provider about it, because you may be on medications, maybe you have some kind of condition. I know one of our beta participants in the program said her husband can’t take adaptogens because he has a congenital heart defect.

So that’s something that we can’t talk about every single little thing that could potentially make a supplement a bad choice for somebody. So we give the information that it’s all based on evidence, it’s all based on the results you get from the adrenal testing, but we always want people to check in with their doctor, or if they’re working with a nutritionist just to make sure, because we don’t want somebody to take something that’s not appropriate, for obvious reasons.

That said, in the program we have generally supplements that we recommend. That’s supplements that are nutrient specific that are pretty good for; anyone that even doesn’t have adrenal fatigue could benefit from taking these. A lot of people are deficient in certain nutrients, so some of the ones we recommend are the types that get depleted when the HPA axis is chronically activated. So we like to replace the ones that are potentially lower.

Then we also make specific recommendations based on the stage of adrenal fatigue. Like I said earlier, if you have high cortisol, we suggest supplements that can help bring that cortisol down. If you have low cortisol, we suggest ones that can help bring it back up or make it more efficient. Then if you have specific times of the day; maybe your cortisol is normal most of the day and then you have a spike at night, which can cause things like insomnia, it’s that tired and wired feeling where you can’t sleep at night. If your cortisol is spiking in the evening, you can specifically time a cortisol reducing supplement around bedtime to make sure that it’s dropping appropriately.

The general supplements we recommend are things like various B vitamins, vitamin C and magnesium, which are the two that get depleted when we’re activating our HPA axis. Then also either probiotics or prebiotics or a combination of the two. Gut health is very connected to adrenal health. There is something called the gut-brain axis which I know Chris Kresser talks a lot about; I’m assuming you guys have talked about it before. But if you don’t have good gut health, or if you have altered gut bacteria, that in itself can actually lead to HPA axis dysfunction.

And then vice versa, where if you have chronic stress and HPA axis issues, that can cause your gut to change. So we like to make sure that people are getting either supplemental probiotics and prebiotics or at least getting it in their food, or maybe a combination of both. And then like I said, in the program we give stage specific supplements that are tailored to the person’s testing. We like to make sure people have gotten their tests first before they start playing around with any sort of adaptogens or herbs or anything like that that can affect their cortisol levels.

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9. Exercising while recovering from adrenal fatigue [51:47]

Diane Sanfilippo: Awesome. So, we have a bunch of questions about healing and movement, and how to kind of stay active and move and exercise dare we say while someone is dealing with this stuff. My number favorite go to has always been Paul Chek’s How to Eat, Move, and be Healthy.

Laura Schoenfeld: Mmm.

Diane Sanfilippo: Because I think he really covers a lot of what he calls working in, and it’s sort of ways to keep physically active and stimulating your muscles without stimulating that fight or flight mode, where you’re just running in that high stress level. I think people can tell when they’re working out and they hit that point of like, ok my heart is really pumping, I’m getting my heart rate up there, and the adrenaline kind of kicks in.

Laura Schoenfeld: Mm-hmm.

Diane Sanfilippo: Versus, there are ways to exercise without having the adrenaline kick in to that level, you know that place. When I talked with Jen Sinkler a couple of weeks ago, she had a coach or a trainer who felt like training high intensity for really short periods of time, and having a lot of recovery between, whatever it might be, they had a theory that that was a better approach, because it retrains your system to not only feel the stress, but then recover, and then go through that process.

Laura Schoenfeld: Mm-hmm.

Diane Sanfilippo: I thought that was interesting. I tend to think that people who are in the throes of it, and are just constantly, and this could be depending on the stage that they’re in. So if they’re in a high cortisol state, I wouldn’t necessarily want them to do that, because they’re already in the high state all the time.

Laura Schoenfeld: Mm-hmm.

Diane Sanfilippo: I would definitely vote for stuff that’s a little more; not low intensity steady state kind of approach, but just not really pushing that adrenaline. But what can you tell people that will encourage them in terms of how to move and what kind of stuff generally like this is consistently what you see as not helping people. And you know we’ve got tons of crossfitters who are listening and also runners, and all of that. So what’s your take on that generally?

Laura Schoenfeld: You know it’s really cool, Jen Sinkler actually contributed a handout for our program, so she gives her recommendations. It’s more about how to get back into exercise when you’ve been healing from fatigue and that kind of thing. And I agree, I think those high intensity, short duration exercises are better for people who maybe are trying to prevent adrenal fatigue, or if you have come out of adrenal fatigue and you’re feeling really good and you want to start doing stuff like Crossfit. I think with Crossfit it really just depends on the coaching, because a good coach will make sure that your workout is not activating your stress response for 40 minutes straight or anything like that.

But there are ways to do intense exercise without pushing yourself into adrenal fatigue, and I think the way Jen explains it, like what you just described and also in our program, she gives a really good explanation as to why that’s helpful.

Now, as far as for people who actually have adrenal fatigue, it really depends on what stage they’re in, what their athletic abilities are, what their current program is, what their other life stressors are. It’s very individual what people should and shouldn’t be doing when they’re in adrenal fatigue. Also it may depend on the situation, so if you’re going through a very stressful period of time, then minimizing high intensity exercise during that period of time just while you’re dealing with other stressors can be helpful. It doesn’t mean you can never do high intensity exercise, it just means you have to be smart about what your combining that with.

I actually made that mistake last week, and I got sick because I was thinking, oh I’m going to go exercise for stress relief, and I’m going to go for a run because it’s 65 degrees out and beautiful, and I woke up the next day after my first long run in I think 4 months.

Diane Sanfilippo: {laughs}

Laura Schoenfeld: And by long, I mean like 4.5 miles, something crazy.

Diane Sanfilippo: Mm-hmm.

Laura Schoenfeld: I woke up, and I immediately was like, that was a mistake. Because I got sick, and I had been sick for 5 days. And it was just one of those things where, again like you said earlier, well I used to be able to run 10 miles and I could be fine afterwards! But because I’m super stressed about this launch, adding even a 4 mile run on top of that was the straw that broke, or was that drop that overflowed my beaker.

Diane Sanfilippo: {laughs}

Laura Schoenfeld: So I didn’t necessarily …

Diane Sanfilippo: Thanks for buying into my analogy there.

Laura Schoenfeld: {laughs} Well I think it’s a good analogy. Again, it’s one of those things where it’s very situational. But the good news is, there are a couple of exercises that we think everyone can benefit from not matter what stage they’re in, and if they’re trying to prevent adrenal fatigue or heal from it. Walking is one of those things that I think gets a lot of I guess attention by the community in general, but isn’t appreciated as much as it should be. Walking outside, especially, now that it’s getting into summer, hopefully.

Diane Sanfilippo: {laughs}

Laura Schoenfeld: Unless you’re in Australia, and you’re going into winter. But really enjoying the outside. Maybe unplugging, not bringing your phone with your or anything like that unless you want to listen to this podcast, which I approve. {laughs}

Diane Sanfilippo: {laughs}

Laura Schoenfeld: And just getting some sunshine, doing whatever amount of walking is appropriate. Maybe that’s 10 minutes, maybe that’s an hour. Whatever stage of adrenal fatigue you’re in, you want exercise to make you feel better and not worse. Yoga is another great one. There’s a lot of evidence that yoga actually can help bring cortisol down, so if you’re in stage 1 adrenal fatigue, then maybe instead of doing Crossfit 5 days a week, you do it 3 days a week, and then do a day of yoga, and then have 2 or 3 days of rest. So doing actual mind body type workouts, which can still help build muscle but are actually designed to lower cortisol is really helpful.

And then like you said before, I think when people think about weight training and things like Crossfit, or high intensity, heavy weights that kind of stuff. You can still do weight training without it being crazy high intensity stress activating.

Diane Sanfilippo: Mm-hmm.

Laura Schoenfeld: One of the things we recommend in our program is what we call low intensity weight training, so maybe that means using some heavier weights but doing less reps and less sets, or one of the things I like to do is 5 reps in 5 sets and taking a decent break in between each set. And using heavy weights; you’re not doing like a 5 pound dumbbell necessarily, but you’re doing it heavy enough that you're building muscle but you’re not fatiguing and you're not working to failure, that kind of thing. And you're not combining that with AMRAPs or sprints in between.

Diane Sanfilippo: Right.

Laura Schoenfeld: I don’t know, I’m trying to think, I haven’t done Crossfit in a while. {laughs} But you know, doing burpees in between.

Diane Sanfilippo: Right. You’re not trying to keep; I mean, I think people can feel it, when your heart rate gets to that really high place.

Laura Schoenfeld: Mm-hmm.

Diane Sanfilippo: It’s just such a perfect physical manifestation. That is a cortisol stress response. It’s normally a healthy thing to do, but when you’re not in the place to reap the benefits of it, you know normally we say the stress of exercise is one of those positive stressors.

Laura Schoenfeld: Mm-hmm.

Diane Sanfilippo: It has that hormetic effect where it’s kind of a negative thing in the short term, but the recovery part makes it a positive thing. Well, when you’re in this state where stress is just too much for your body, you’re not going to get that positive effect from it. You’ll get, like you were saying, the injuries, or you’re just burned out for too long after the exercise, and I think it’s really important to remember. When I was working on Practical Paleo, and I was talking to Robb Wolf about it, because he went through writing a book. I was like, dude, I know what to do, you have to tell me though, because that will help me actually do it. He was like, I want you only lifting not more than probably 5 reps. It was probably 1-3 even what he told me, and don’t make that face of {grrr}.

Laura Schoenfeld: Yeah.

Diane Sanfilippo: You know, the strenuous, gut wrenching, get this weight up. That face that we make, and that strain, when you’re straining to that level. And I think this is where, for crossfitters, body building type movements, either seated or standing, like dumbbell shoulder press, even curls or triceps extension, that kind of thing. That stuff gets a bad name because people don’t think of it as functional fitness, but if Crossfit is not the thing that’s working for you right now… A few months ago I stopped crossfiting, because I was like, my body just feels stressed.

Laura Schoenfeld: Mm-hmm.

Diane Sanfilippo: Whatever is going on, I’m like, I can’t go in there and move quickly with this heavy weight. It just doesn’t feel right right now. So I started working one on one with a trainer, and every day I’ll tell her, here’s how I’m feeling, here’s what I feel like I need today. I know myself well enough, and she designs, even if it’s similar movements she was going to have me do because she kind of has a plan for me, she’ll adjust it and say, ok you feel pretty good today we can do this, or if you’re feeling more tired and you're recovering, we won’t do that metabolic work. We’ll do more strength and keep it in this way. So I think that’s really important for people to keep in mind.

And what you said earlier; just because it’s not ok for right now doesn’t mean you can’t come back to it. I think everybody needs to remember that. It’s the same when it comes to food, right? We’re like, ok right now we don’t want you to eat this for a little while. But those foods are always there.

Laura Schoenfeld: Right.

10. How can HPA axis dysregulation affect our hormones [1:01:24]

Diane Sanfilippo: It’s like, this stuff never goes away. So I think that’s really great information. I think we had; well, you know, you talked a little bit about the hormonal effects of the HPA axis in your own story just a little bit. Is there anything else you can touch on, even just briefly, because we did have a few questions but we’re closing out on well into an hour here, and I know the show is going to go a little bit longer, but it’s such a great topic. Anything else that you want to talk about in terms of how this HPA axis dysregulation can affect our hormones. I think this definitely affects women more than men, but obviously testosterone levels and sex hormones for men, as well. But is there something we can let people know about that, just kind of in general to keep in mind, because if they’re dealing with hormonal issues, perhaps this is the root cause.

Laura Schoenfeld: Yeah, I think like you said, women, for whatever reason, are a lot more prone to it. It’s probably because the first thing that gets shut down when you're stressed or low calorie diet is your reproductive health. Your body is protecting you against getting pregnant, because if you’re not able to support a pregnancy, then that can be very dangerous. So your body starts to shut down any hormones that can keep you fertile as one of the first things that it does, so I think that’s one of the big reasons why women are more prone to it. With men, it’s like, yeah it wouldn’t be great to have a baby, but the man is not very involved from a physical perspective with growing a child, so I don’t think it’s quite as dangerous for them to stay fertile, even if they’re in a dangerous or stressful experience.

It’s really interesting, I did a bonus video for the program called sex hormones and thyroid health and how it’s affected by adrenals. It’s not actually called that, I just said that off the top of my head. But it’s all about how not only is there an HPA axis, so like I said before, hypothalamic pituitary adrenal, there is also a hypothalamic pituitary gonadal axis, which controls the testes and the ovaries, which are your major sex organs. And then there’s an HPT axis, so that’s the hypothalamic pituitary thyroid axis, and that will affect the thyroid hormone output. And then, just to make it even more complicated, there’s also an OAT axis, which is the ovarian adrenal thyroid axis.

So in women, those three hormonal systems actually all interplay with each other. So if your cortisol is high it affects how well your thyroid hormones are functioning. Your thyroid itself may be working just fine, but the actual hormones get messed up because the high levels of cortisol make you less receptive to thyroid hormones. Same go for the sex hormones from the ovaries. And then also, like I said earlier, your ovaries start to produce less sex hormones in response to that high cortisol demand. Interestingly, your adrenals also produce some level of sex hormones, too.

So there’s just a lot of different hormonal balances that are going to get messed up if you’re doing things that are chronically affecting your HPA axis. These kinds of things can lead to, like I said before, low progesterone is a really common outcome of HPA axis issues. That leads to something called estrogen dominance. A lot of times, we think of estrogen dominance being from excessive levels of estrogen, but in fact it just means that your estrogen and progesterone are out of balance. So if you have really low progesterone, you can have low estrogen also and still have estrogen dominance symptoms. So that can cause weight gain and really bad PMS symptoms, infertility, that kind of thing.

Then with the thyroid, like I said before, if you are having high levels of cortisol all the time, that not only suppresses your TSH output, so that hormone that doctors tend to look at if you’re just going to a conventional doctor that wants to test your thyroid, they’re going to want to look at your TSH. And if your cortisol is high, that actually lowers your TSH. So it can kind of give you that false sense of security that your thyroid is ok. It also reduces the conversion of T4 to T3, which T3 is your active thyroid hormone, and it also increases the conversion of T3 to the inactive reverse T3. So these 3 major changes are what actually causes many of the hypothyroid symptoms when someone has adrenal fatigue, even if they have a normally functioning thyroid gland. They may even have normal looking labs, especially if they’re only looking at things like TSH or free T4.

Those two systems are really intimately tied up with your adrenal function. And like I said before, you may have normal cortisol levels, but your progesterone is in the toilet or your reverse T3 is super high and you're having those hormonal balance symptoms.

We do talk about that in the program, and we also give people the option to get that stuff tested if they want. People can even order the test through our website, so it’s one of those things where we like to have people see a doctor or a naturopath or a chiropractor or whoever is monitoring that stuff for them, but like you said at the beginning, not everyone has access to integrative and functional medical practitioners, so if you can get those tests ordered yourself, at least you have a general sense of what’s going on, and maybe you can take those labs to somebody who can help you get them sorted out.

The hormone balance thing is crazy complicated and I know we’re going really long, so I don’t want to go too much into it.

Diane Sanfilippo: Yeah.

Laura Schoenfeld: Hopefully that gives people a good overview of what kind of things can happen. And then really quick, with low progesterone, sometimes the way you can figure out if that’s happening, even if you don’t have tests done is if you have a really irregular cycle, whether it’s just all over the place, your menstrual cycle is shorter than 21 days, longer than 36 days, maybe you don’t have a cycle at all. And also, you can either have really bad PMS symptoms, or you can actually have absence of normal PMS symptoms like breast tenderness and mid cycle ovarian pain. There’s a lot of different fertility signs that can show if you’re having stress related hormonal imbalances. I think women can figure that out pretty quickly when they’re having lots of different menstruation issues. So that’s something to definitely pay attention to.

Diane Sanfilippo: We have a brand new sponsor who I’m super excited about. Joining us this month is Tin Star Foods Ghee. As any of you who have been following me on social media know, I’m a huge fan of the product. I don’t generally talk a lot about products that I’m not a big fan of, so I wanted to invite Tin Star to come on and be a sponsor. I’m really excited to introduce those of you who haven’t heard of it yet to this ghee.

For those of you who aren’t sure what ghee is, it’s clarified butter, so if you’re sensitive to dairy proteins, it’s a really good option. For people who are highly, highly allergic, it maybe for you, it maybe not. I know that Tin Star Ghee is certified as casein free as well as lactose free, but there are some folks who will always be sensitive. So if you’re a little bit borderline and you feel like you can handle a tiny bit, which that’s where I am at, I would definitely recommend it. I definitely don’t do well with butter, and the Tin Star Ghee is fantastic for me. Ghee has been clarified, so the dairy proteins are gone, and I have no problems with it whatsoever. It tastes fantastic, and it’s a very healthy cooking fat. It’s my number one go-to choice for cooking.

So if you’re looking for an alternative to something like coconut oil or other animal fats that have different types of flavors, ghee is a fantastic choice. I just used it this morning to scramble my eggs, and it’s one that I highly recommend. The flavor and texture of Tin Star Foods ghee is fantastic. I absolutely love Hima, who is the owner of the company. She’s is just a really hard working gal getting her company off the ground, and I love supporting her. So I’m excited to have them join us as a sponsor, so welcome Tin Star Foods Ghee.

Diane Sanfilippo: Awesome. This was a really good episode. I love this so much.

Liz Wolfe: Yay! {laughs}

Diane Sanfilippo: Really good information for everyone listening. I’m super excited about the program. That’s all we have for this week. You guys can find details about Laura and Kelsey’s Paleo Rehab program for overcoming adrenal fatigue via the podcast post over at BalancedBites.com. This will be episode 189, so just hop over to the website if you’re not doing it in a timely fashion when we’re releasing the episode, you can always click on podcast and check out the archive links and see the episode there. We also have, like I said, I think there are 3 episodes we’ve done in the past on this topic, but Laura and Kelsey are probably covering everything that we’re covering on those episodes and more right within the program, so just hop over to BalancedBites.com and you’ll see the link for it right there in the post.

Don’t forget you can always find Liz, my podcasting co-host, who is on maternity leave https://realfoodliz.com/, and don’t forget to join our email lists where we share free goodies and updates you don’t find anywhere else on our websites or on the podcast.

Laura Schoenfeld: I just wanted to make sure people knew since this is a timely issue.

Diane Sanfilippo: Oh, that’s right.

Laura Schoenfeld: If you guys sign up for our program before 12 p.m. eastern time on May 4th, which is a Monday, we are throwing in 10 free hours of, we call them office hours, so we’re going to do twice a week office hours during the first 5 weeks during the program.

Diane Sanfilippo: Ooh, love that.

Laura Schoenfeld: Which means Kelsey and I are going to be on the call live. You can come in, ask us any questions you want. Our beta testers absolutely loved the office hours. We were actually surprised {laughs} everyone said that was their favorite part of the program, because they got the opportunity to ask questions about digestive issues, hormone issues, things that it’s hard to cover in a general education program, because it’s very specific. But they all loved it, and it was a really successful part of the program. So the program will be available forever, or as long as the internet exists, I guess.

Diane Sanfilippo: {laughs}

Laura Schoenfeld: For as long as I’m working. So if you miss this, you can still join the program and we’ll be happy to have you. You can join our private Facebook group for members of the program, but I just wanted to say that because like I said, I don’t want people to miss out on the bonus of the 10 office hours. So we want to see you guys in there, I’m so excited.

Diane Sanfilippo: Awesome. Yeah, that’s fantastic. That’s kind of invaluable, and probably the price of the program will be worth just coming in and asking questions. So that’s great. Let’s see, so that’s pretty much it. While you guys are on the internet, don’t for get to leave us a review in iTunes. We will see you next week.

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